Objective: Our aim was to assess the impact of six recommendations regarding drug prescription on the clinical practices of French psychiatrists. The recommendations were part of the conclusions of a consensus conference entitled “Long-term therapy of schizophrenia” (Paris, January 1994).

Methods: The impact of the conference was assessed on the basis of awareness of the existence of the conference, knowledge of its conclusions, and actual changes in clinical practice. We performed: a) a survey of a representative sample of 396 psychiatrists 2 years after the conference; and b) an analysis of changes in drug prescriptions in a cohort of 2,407 patients with schizophrenia under treatment at the time of the conference.

Results: Overall, 78% of interviewed psychiatrists were aware of the existence of the conference and 70% of its conclusions. Declared prescription practices conformed with conference conclusions about 60% (10%–95%) of the time. No difference in practices was noted between psychiatrists who were aware of the recommendations and those who were not. Single neuroleptic prescriptions increased in the cohort study in line with the main conference recommendation. The increase was small, but significant from 51.1% to 56.4%, and mainly concerned patients recently put on treatment. Contrary to recommendations, prescriptions of anticholinergics plus neuroleptics inexplicably rose from 48.2% to 54.3%.

Conclusion: Small changes in prescription habits occurred in the wake of the consensus conference, but we cannot really ascribe them to a direct impact of the conference. Despite the great pains we took in disseminating the conclusions of the conference as widely as possible, it is clear that a more forceful action plan (e.g., including continuous medical education) is required.

Objectives: Single-vessel bypass can often be accomplished through less invasive techniques than conventional coronary artery bypass graft (CABG) at substantially lower cost. We undertook a study to empirically determine the cost savings associated with one such technique, left anterior small thoracotomy (LAST).

Methods: Reviewing medical and billing records, we measured the difference in hospitalization costs between two methods of coronary bypass surgery. The study groups consisted of 50 patients who underwent LAST and 28 who underwent single-vessel conventional CABG during 1995 and 1996. A subsequent validation sample of 50 patients who underwent LAST was also analyzed. Hospitalization costs were estimated using a relative value unit methodology and were risk-adjusted for both perioperative risk factors and changes in operating room technology.

Results: Risk-adjusted hospitalization costs for those undergoing LAST were $9,510 and $12,546 for the CABG control subjects (p < .01), with differences in surgical costs reflecting over 62% of this overall difference. Differences in average length of stay were under a half-day (10.0 for LAST vs. 10.46 for CABG). Only one inpatient fatality was reported; therefore, no inference regarding mortality differences could be made.

Conclusions: LAST is substantially less costly than conventional surgery, and the savings are potentially greater if hospital length of stay is reduced to a clinically recommended time of 2 days.

Objective: A basic issue in randomized controlled trials (RCTs) is whether we can safely assume comparability between groups at baseline with respect to all potentially important prognostic factors. In other words, did randomization work sufficiently well? In small trials balanced allocation procedures are employed, whereas in large-scale trials simple randomization will do. The question is: When should balancing be considered?

Methods: We performed a simulation study in which we varied the number of categories in the prognostic factors and the number of patients.

Results: Simulation showed that, in all instances, a balancing procedure almost always led to perfect or almost perfect balance, while the imbalance with simple randomization was larger. To study the effect of balanced and random allocation on subgroup analyses in our OME trial, we compared the quotient of the width of the confidence intervals (CI). The widest CI in random allocation over the 13 hospitals was on average 13% wider than in balanced allocation.

Conclusion: Investigators should always consider balanced allocation, especially in categories with a low number of patients and when subgroup analysis over many categories is requested.

There is a growing interest in the potential use of conjoint analysis (CA) as a tool for estimating patient preferences within the economic evaluation of healthcare technologies. It has been suggested that where cost is included as one of the attributes within the exercise, CA can be used to estimate willingness to pay (WTP) for healthcare interventions indirectly within the framework of cost-benefit analysis. While recognizing the potential advantages of CA as a technique for the assessment of benefits in health care, this paper recommends several avenues of investigation that need to be carefully explored before an informed judgment can be made as to the validity of eliciting WTP values using the CA methodology. It is argued that much can be learned from the use of qualitative research techniques in examining individuals' understanding and interpretation of CA questions where cost is included as an attribute in the exercise. Additionally, further research is required in defining techniques for establishing the most appropriate levels for the cost attribute in a CA exercise and in determining the sensitivity of WTP estimates to the levels that are chosen for the cost attribute.

Objectives: The EUR-ASSESS project was undertaken by a large number of members of European health technology assessment (HTA) agencies and programs with the aim of improving coordination through developments in several areas of HTA. At the conclusion of the project, an independent survey was undertaken to reassess the importance of the original objectives of EUR-ASSESS and determine the impact of the project on the way HTA activities are organized and carried out in Europe.

Methods: A postal questionnaire survey and a series of more in-depth personal interviews.

Results: EUR-ASSESS was generally considered successful in achieving its aims, particularly in creating an informal network of people and organizations, improving the understanding of the work of others, improving the ability to focus the objectives of HTA, facilitating the sharing of experience and mutual learning opportunities, exchanging ideas on research agendas, and developing a common language. However, significant differences emerged in the expectations of different actors in European HTA, and in their perceptions of the impact of the project. These reflect the wide diversity of approaches existing in Europe.

Conclusions: Health technology assessment in Europe is changing its nature from a set of national or local initiatives with relatively limited impact to a truly European movement with strong links and coordination between its individual components. Important lessons can be learned from the experience of EUR-ASSESS, particularly in the light of an increasing commitment of the European Commission to play a role in the development of technology assessment.